Impact of Uterine Artery Embolization on Subsequent Fertility Outcomes: A Meta-Analysis of 20 Years of Clinical Evidence

Background: Uterine fibroids affect 70–80% of women by age 50, often impairing fertility through mechanical distortion and altered endometrial receptivity. Uterine artery embolization (UAE) is a minimally invasive alternative to surgery, though its impact on future fertility remains debated. This meta-analysis aimed to evaluate pregnancy rates, time to conception, and fertility-related complications following UAE in women with symptomatic fibroids. Methods: A systematic search was performed across PubMed/MEDLINE, Embase, Cochrane Library, Web of Science, and other databases (January 2005–March 2025) following PRISMA 2020 guidelines. Studies reporting fertility outcomes ≥ 6 months after UAE were included. Primary outcomes were pregnancy rates and time to conception. A random-effects meta-analysis was conducted using Review Manager 5.4. Study quality was assessed with the Newcastle–Ottawa Scale (observational studies) and the Cochrane Risk of Bias tool for randomized controlled trials (RCTs). Results: Thirty-three studies (4287 women) were included; 85.2% had follow-up. The pregnancy rate was 52.1% (95% CI: 46.8–57.4%), with a mean time to conception of 14.7 months. Pregnancy rates were highest in women < 30 years (67.8%) and lowest in those > 40 years (31.5%). Unilateral UAE had superior outcomes to bilateral (61.2% vs. 49.8%). Conclusions: UAE can preserve fertility in ~50% of selected patients, with better outcomes in younger women. Early intervention is advised for fertility preservation.